Monday, August 30, 2010

Journal Entry: Aug 27-28, 2010

The women come and come. Very few moments in the labor ward at night are quiet and without a woman in labor. The women come into the delivery rooms when they think they are ready to deliver. They are checked by a midwife or student. If she’s 9 cm or more, she stays and waits to feel the urge to push. If she is less than 8cm, she is sent back walking. Tonite we arrive and there are no sterile instruments. The autoclave is packed and I press the button that turns it on (once we have electricity again, that is). I’m not sure if it’s really working though. The midwives are not sure how the autoclave functions.

We can’t find cord clamps either. I know we had a huge bag full the other day. Ami and I will need to go to the storage room tomorrow and restock. Of the delivery areas, room 5 has two delivery tables. We still need to teach the midwives to use a private room as long as one is open. They gravitate towards putting the women in the same room.
The first mom this evening is having her second child. She pushes out a strong, healthy boy. She doesn’t loot at the baby. I tell her congratulations and that she’s done a good job. The baby is big and beautiful and healthy. My Creole for birth is improving every day. I place the mother’s hands on the baby on her chest. She does not engage.

I am reminded of how harsh these conditions are. Can you really fall in love with your baby if it’s chance of surviving its first 5 years is questionable. Can you open up to your baby if there is another woman laboring 3 feet away from you?
I pull the Haitian midwife aside to scheme about how to get this mom to bond with her newborn. The midwife hasn’t been so nice to her, so I want to engage the midwife on a different level too. In a whisper, I tell the midwife that the mother isn’t bonding well with the baby. I suggest that if she talks to the mother, telling her that she did a good job, that her baby is so beautiful, that her baby is so smart, that the mother will bond with the baby. If the mother is happy, the baby will be happy. If the mother is sad, the baby will be sad. Not far from her years as a student, the midwife complies. She talks to the mother. The midwife is more animated and engaged in the joy of a live birth. I see her smile.
The mother begins to respond when we tell her the good news — she has a healthy baby. 
Baby number 2 is a 17 year old mother, having her first baby. She screams so loud on her final push that I have to walk away from her for a second. The screaming brings the baby and she has a healthy baby girl.

I can tell that this mom has a small tear. I ask Bieneme, the midwife, if she would like to sew or would she like me to do it. She says she knows how to sew and that I can do it.
I want Esther and Bieneme, the midwives, to watch the suturing. I am here to teach. I tell them that I have been a midwife for 24 years and I still watch other people suture. Esther is eager to watch, she was with me on the first night as well. She thanks me a lot for showing her. I get the feeling that they don’t suture often because few women actually tear. Bieneme says she practiced a lot in class on foam. I say that it is different on people and that we should always watch so that we can show each other new tricks.
The third baby of the night, a healthy baby girl, is born in the postpartum ward.
The postpartum ward is a large room with 10 beds. Every bed is full with at least one person and some women are sleeping on the floor. This is also where some of the women wait while they are in labor.
Adeline and Bieneme are chatting in Room 1 when we all hear the loud grunting of a baby coming from across the courtyard. Bieneme springs into action and is out in a flash. Before I even get up from where I am sitting, I hear the lusty cries of a fresh baby from the other room.
It’s a girl, big, strong, covered in vernix. The mom’s fifth girl. I can sense she is a little disappointed. She also has two boys at home. Being a 7th time mom, her labor had putzed and putzed, and she had been continually sent out of the labor ward, not ready. As oft will happen with grand multips, with one final wave of intensity, the baby was born.
A mouse scampers across the floor of the delivery ward. It is 1:30am and 3 babies have been born since we arrived at 8. Thankfully, they are all beautiful and healthy. The pace tonite is steady but manageable. The albino gecko is on the ceiling.

At 3:10am, the 7th time mom is brought in from the postpartum ward. She is having heavy bleeding. Bieneme does an exam and removes about 250cc of clots. The mother has already lost at least 500cc. The midwife is discussing cytotec in Creole. I wake SheLove to help me with the translation. I get 800 mg of cytotec from the Cabinet. I motion to hand the tablets to Bieneme. She says, “You do it.” I place the tablets rectally that are known to be the savior of mothers in the developing world. The husband comes in and brings the tubing and Lactated Ringers that he bought at the pharmacy. This means we can give her IV pitocin. The women are required to buy their own IV supplies because all the other patients in the hospital have to do it that way and they do not want the pregnant women to set a precedent. The injustice of this seems absurd to me. Are they really going to withhold a simple life-saving treatment because they are afraid of offending the other patients? Isn’t a maternal death from postpartum hemorrhage far more offensive?

Thankfully this woman had the resources. We give her the IV. Soon she is snoring and her vitals are very stable. We let her sleep. I tell Bieneme that since she is a grand multip and has lost more than the usual amount of blood, that we need to check her vitals and bleeding every 15 minutes for about an hour or so. Bieneme looks at me and simply says that she is going to sleep. Bieneme is not a student, she is one of the paid midwifery staff. Thus, I can’t really instruct her what to do. Instead, I model, “I’ll watch her then.” Thankfully, the mom’s vitals stay stable and the modeling may have worked. Sometime in the morning I see Bieneme go in to check in on the mom. I asked Ami, “Is she going to check her blood pressure?” As Ami nods her head, I say, “Bon.”

A fourth baby is born before the night is over, another girl. Around 4am, the electricity goes off in the hospital in anticipation of the light of day. We have to work by flashlight and headlamps until the sun comes up. By morning, with all the baby’s born and the 7th timer sleeping, the midwives congregate in Room 3, our usual charting station. We chat, take photos and relax now that all is quiet and the shift is almost over.

Ami and I walk home at around 6am. It is bright daylight and cooler than midday. There is a pick-up soccer game already in action across from the hospital. The field is also where the dirt runway is for the small, 6-seater planes that fly into Hinche.

Women are selling food along the side of the road — fried plantains, avocados, hard boiled eggs, sundries. As we pass the empty churches, the ethereal sound of the church choirs practicing seeps onto the street.

The mile and a half walk home is grounding and peaceful. We are happy to be here in Hinche.

No comments: